2016―2018年广东省艾滋病抗病毒治疗者首年死亡率分析

First-year mortality after antiretroviral therapy initiation among people living with HIV/AIDS in Guangdong from 2016 to 2018

目的了解广东省2016―2018年新接受抗逆转录病毒治疗(antiretroviral therapy,ART)的感染者/艾滋病患者(简称HIV/AIDS患者)治疗首年死亡率变化趋势,比较与探索“广东艾滋病社区综合防治研究项目”广州市示范区、广州市非示范区及广东省其他市的HIV/AIDS患者死亡率差异及原因,为AIDS死亡防控工作提供依据。方法基于国家艾滋病抗病毒治疗信息系统与《中国死因监测数据集》,分析2016―2018年在广州市第八人民医院新接受ART的HIV/AIDS患者,治疗首年死亡率和标准化死亡率比(standardized mortality ratio,SMR);采用Cochran-Armitage趋势检验分析2016―2018年各年新接受治疗患者的治疗相关指标的变化趋势;采用Cox回归探索不同地区HIV/AIDS患者治疗首年死亡率差异的原因。结果2016―2018年共6447名HIV/AIDS患者新接受ART,广州市示范区、广州市非示范区和广东省其他市的患者分别为976、3921和1550人;期间死亡152人。2016―2018年广州市示范区患者的治疗首年死亡率下降79.7%,广州市非示范区患者死亡率下降趋势不明显,广东省其他市患者死亡率上升18.8%;经标化后,三组现住址患者的SMR均呈现下降趋势。三组患者的早治疗率随开始治疗年份增加而增加,但是仅广州市的患者疗效随年份增加改善显著。Cox回归结果显示在校正不同地区患者的基线特征以及项目实施过程中控制效果良好的因素后,三组现住址患者死亡率差异均无统计学意义(均有P>0.05)。结论项目实施下,广州市HIV/AIDS患者治疗首年死亡率得到控制,特别是示范区患者首年死亡率在2018年下降至较低水平,但广东省其他市患者死亡率相对较高且可用较差的基线特征与治疗相关指标解释。对于在广州市接受治疗且居住在广东省其他市的HIV/AIDS患者,掌握疗效较差原因,积极促进早治疗以提高ART疗效是降低这部分患者首年死亡率的关键。

Objective To estimate the trends in first-year mortality among HIV/AIDS patients newly receiving antiretroviral therapy(ART)in Guangdong Province from 2016 to 2018.To compare the differences in mortality among HIV/AIDS patients from different regions in Guangdong during the“Guangdong AIDS Community Integrated Prevention and Treatment Research Project”.Methods We estimated the annual first-year mortality after ART and standardized mortality ratio(SMR)of HIV/AIDS patients receiving ART at Guangzhou Eighth People’s Hospital.And we analyzed the changes in patients’treatment characteristics using Cochran-Armitage tests.Finally,we explored the differences in first-year mortality of HIV/AIDS patients from different regions using Cox regressions.Results During 2016-2018,a total of 6447 HIV/AIDS patients newly started ART.The number of patients in Guangzhou demonstration districts,other districts in Guangzhou and other cities in Guangdong Province were 976,3921,and 1550,among that 152 people died.From 2016 to 2018,first-year mortality in Guangzhou demonstration districts decreased by 79.7%.The mortality in other districts in Guangzhou did not decline significantly,and the mortality of patients in other Cities in Guangdong increased by 18.8%.After standardization,SMR of three groups of patients all decreased.Among three groups,the early-diagnosis rates increased by year.But only HIV/AIDS patients living in Guangzhou had significant improvement in treatment outcome over the year.Cox regressions showed that after adjusting for baseline characteristics and factors being well controlled during the program implementation,differences in mortality rates no longer existed among patients in the three residence groups.Conclusions The first-year mortality of HIV/AIDS patients receiving ART in Guangzhou was well-controlled,especially patients from demonstration districts.But patients in other cities in Guangdong had high mortality,which could be explained by their poor physical conditions.For patients with HIV/AIDS receiving ART in Guangzhou but living in other cities in Guangdong Province,to focus on the poor ART outcomes and actively promote early treatment are crucial in reducing their first-year mortality.